Detoxification treatment for heroin dependents adolescents

Review question

We reviewed the evidence on the effect of detoxification treatment compared with pharmacological maintenance treatment or psychosocial intervention in achieving abstinence on adolescents heroin dependents.

Background

Substance abuse among adolescents (13 to 18 years old) is a serious and growing problem. It is important to identify effective treatments for those who are opioid dependent. For adults, pharmacotherapy is a necessary and acceptable part of effective treatment. Detoxification agents are used to reduce withdrawal symptoms during managed withdrawal but the rate of completion of detoxification tends to be low, and rates of relapse are high. Withdrawal symptoms, particularly drug craving, may continue for weeks and even months after detoxification. The period of recovery from dependence is typically influenced by a range of psychological, social and treatment- related factors. Detoxification treatments include methadone, buprenorphine, and alpha2-adrenergic agonists.

Study characteristics

The review authors searched the literature for randomised controlled trials investigating pharmacological interventions with or without psychosocial intervention aimed at detoxification in adolescents. They found only two trials, both conducted in the USA; one compared 28-day treatment with buprenorphine, using tablets placed under the tongue, to wearing a clonidine patch in 36 opiate dependent adolescents who were treated as outpatients. The other trial compared maintenance treatment versus detoxification treatment: buprenorphine-naloxone maintenance versus buprenorphine detoxification.

Key results

The trial comparing buprenorphine with clonidine reported a trend in favour of buprenorphine in reducing the drop-out rate but no difference between treatments in the duration and severity of withdrawal symptoms. More participants in the buprenorphine group went on to long-term naltrexone treatment. Side effects were not reported. In the second trial comparing buprenorphine maintenance versus buprenorphine for detoxification, for drop out the results were in favour of maintenance treatment, At one-year follow- up, self-reported opioid use was clearly less in the maintenance group and more adolescents were enrolled in other addiction programs. Conducting trials with young people may be difficult for both practical and ethical reasons.

Quality of the evidence

This review was limited by the very few number of trials retrieved and the quality of the evidence was moderate for the comparison between buprenorphine and clonidine and low for the comparison between buprenorphine detoxification and buprenorphine maintenance. The evidence is current to January 2014.